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FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 401k Plan overview

Plan NameFLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN
Plan identification number 501

FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

FLOOD & PETERSON INSURANCE INC. has sponsored the creation of one or more 401k plans.

Company Name:FLOOD & PETERSON INSURANCE INC.
Employer identification number (EIN):840475762
NAIC Classification:524210
NAIC Description:Insurance Agencies and Brokerages

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-07-01JILL LARSON
5012016-07-01JILL LARSON
5012015-07-01JILL LARSON
5012014-07-01FLOOD & PETERSON INSURANCE INC.
5012013-07-01FLOOD & PETERSON INSURANCE INC.
5012012-07-01FLOOD & PETERSON INSURANCE INC.
5012011-07-01FLOOD & PETERSON INSURANCE INC.
5012009-07-01FLOOD PETERSON INSURANCE INC.

Plan Statistics for FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN

401k plan membership statisitcs for FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN

Measure Date Value
2017: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01105
Total number of active participants reported on line 7a of the Form 55002017-07-01111
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01111
2016: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01107
Total number of active participants reported on line 7a of the Form 55002016-07-01105
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01105
2015: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01101
Total number of active participants reported on line 7a of the Form 55002015-07-01107
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01107
2014: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01105
Total number of active participants reported on line 7a of the Form 55002014-07-01112
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01112
2013: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01101
Total number of active participants reported on line 7a of the Form 55002013-07-01105
Total of all active and inactive participants2013-07-01105
2012: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01102
Total number of active participants reported on line 7a of the Form 55002012-07-01101
Total of all active and inactive participants2012-07-01101
2011: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01106
Total number of active participants reported on line 7a of the Form 55002011-07-01102
Total of all active and inactive participants2011-07-01102
2009: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01114
Total number of active participants reported on line 7a of the Form 55002009-07-0195
Total of all active and inactive participants2009-07-0195

Financial Data on FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN

Measure Date Value
2015 : FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2015 401k financial data
Total income from all sources2015-06-30$0
Total plan assets at end of year2015-06-30$0
Total plan assets at beginning of year2015-06-30$0
Net plan assets at end of year (total assets less liabilities)2015-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2015-06-30$0
2014 : FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2014 401k financial data
Total income from all sources2014-06-30$0
Total plan assets at end of year2014-06-30$0
Total plan assets at beginning of year2014-06-30$0
Net plan assets at end of year (total assets less liabilities)2014-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2014-06-30$0
2013 : FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2013 401k financial data
Total income from all sources2013-06-30$0
Total plan assets at end of year2013-06-30$0
Total plan assets at beginning of year2013-06-30$0
Net plan assets at end of year (total assets less liabilities)2013-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2013-06-30$0
2012 : FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2012 401k financial data
Total income from all sources2012-06-30$0
Total plan assets at end of year2012-06-30$0
Total plan assets at beginning of year2012-06-30$0
Net plan assets at end of year (total assets less liabilities)2012-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2012-06-30$0

Form 5500 Responses for FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN

2017: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2009: FLOOD & PETERSON INSURANCE INC HEALTH & WELFARE PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00449249
Policy instance 1
Insurance contract or identification number00449249
Number of Individuals Covered111
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, OPTIONAL LIFE & AD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $72,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00449249
Policy instance 1
Insurance contract or identification number00449249
Number of Individuals Covered107
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,185
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, OPTIONAL LIFE & AD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $71,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1185
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameFLOOD & PETERSON INSURANCE INC.
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9754938
Policy instance 3
Insurance contract or identification number9754938
Number of Individuals Covered24
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number09576
Policy instance 2
Insurance contract or identification number09576
Number of Individuals Covered101
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Vision Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (OPTIONAL LIFE)
Welfare Benefit Premiums Paid to CarrierUSD $44,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameFLOOD & PETERSON INS INC
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3131778
Policy instance 4
Insurance contract or identification numberE3131778
Number of Individuals Covered11
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $806
Total amount of fees paid to insurance companyUSD $77
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $806
Amount paid for insurance broker fees77
Additional information about fees paid to insurance brokerBONUSES AND NON-CASH COMPENSATION 3
Insurance broker nameCOLONIAL LIFE
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000009391
Policy instance 5
Insurance contract or identification number000009391
Number of Individuals Covered76
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number23522
Policy instance 6
Insurance contract or identification number23522
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of fees paid to insurance companyUSD $174
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees174
Insurance broker nameFLOOD & PETERSON BENEFITS LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010177189
Policy instance 7
Insurance contract or identification number000010177189
Number of Individuals Covered100
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Life Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (AD&D)
Welfare Benefit Premiums Paid to CarrierUSD $18,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number902623
Policy instance 8
Insurance contract or identification number902623
Number of Individuals Covered158
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $332,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number23522
Policy instance 1
Insurance contract or identification number23522
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameFLOOD & PETERSON BENEFITS LLC
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000009391
Policy instance 5
Insurance contract or identification number000009391
Number of Individuals Covered93
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number23522
Policy instance 6
Insurance contract or identification number23522
Number of Individuals Covered177
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,111,960
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameFLOOD & PETERSON BENEFITS LLC
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010177189
Policy instance 7
Insurance contract or identification number000010177189
Number of Individuals Covered105
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Life Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (AD&D)
Welfare Benefit Premiums Paid to CarrierUSD $15,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3131778
Policy instance 4
Insurance contract or identification numberE3131778
Number of Individuals Covered13
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $1,099
Total amount of fees paid to insurance companyUSD $188
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,099
Amount paid for insurance broker fees188
Additional information about fees paid to insurance brokerBONUSES AND NON-CASH COMPENSATION 3
Insurance broker nameCOLONIAL LIFE
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9754938
Policy instance 3
Insurance contract or identification number9754938
Number of Individuals Covered23
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number09576
Policy instance 2
Insurance contract or identification number09576
Number of Individuals Covered107
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Vision Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (OPTIONAL LIFE)
Welfare Benefit Premiums Paid to CarrierUSD $49,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameFLOOD & PETERSON INS INC
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number23522
Policy instance 1
Insurance contract or identification number23522
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of fees paid to insurance companyUSD $341
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees341
Insurance broker nameFLOOD & PETERSON BENEFITS LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number09576
Policy instance 2
Insurance contract or identification number09576
Number of Individuals Covered100
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Vision Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOTHER (SPECIFY)
Welfare Benefit Premiums Paid to CarrierUSD $43,163
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameFLOOD & PETERSON INS INC
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9754938
Policy instance 3
Insurance contract or identification number9754938
Number of Individuals Covered30
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3131778
Policy instance 4
Insurance contract or identification numberE3131778
Number of Individuals Covered13
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,577
Total amount of fees paid to insurance companyUSD $641
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,577
Amount paid for insurance broker fees641
Additional information about fees paid to insurance brokerBONUSES AND NON-CASH COMPENSATION 3
Insurance broker nameCOLONIAL LIFE
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000009391
Policy instance 5
Insurance contract or identification number000009391
Number of Individuals Covered102
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number23522
Policy instance 6
Insurance contract or identification number23522
Number of Individuals Covered82
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of fees paid to insurance companyUSD $516
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $934,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees516
Insurance broker nameFLOOD & PETERSON BENEFITS LLC
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number23522
Policy instance 1
Insurance contract or identification number23522
Number of Individuals Covered68
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameFLOOD & PETERSON BENEFITS LLC
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number23522
Policy instance 1
Insurance contract or identification number23522
Number of Individuals Covered85
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number09576
Policy instance 2
Insurance contract or identification number09576
Number of Individuals Covered94
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Vision Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedOTHER SPECIFY
Welfare Benefit Premiums Paid to CarrierUSD $44,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9754938
Policy instance 3
Insurance contract or identification number9754938
Number of Individuals Covered30
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE3131778
Policy instance 4
Insurance contract or identification numberE3131778
Number of Individuals Covered11
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $1,061
Total amount of fees paid to insurance companyUSD $185
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number000009391
Policy instance 5
Insurance contract or identification number000009391
Number of Individuals Covered106
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number23522
Policy instance 6
Insurance contract or identification number23522
Number of Individuals Covered88
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of fees paid to insurance companyUSD $630
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $877,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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